Feedback Summary: Breaking Bad News and Dementia with Weight Loss

Updated: Aug 1

Minimize Data Gathering: Limit the data gathering phase to essential information only. Focus on what is absolutely necessary to know about the patient’s condition and avoid excessive probing about details already provided.
Understanding the Patient's Knowledge: Determine what the patient or their family already knows about the condition. This helps tailor the conversation and avoid redundant questions.

Setting the Scene:
- Introduce yourself and explain the purpose of the discussion.
- Ensure the environment is conducive to a sensitive conversation (quiet, private).
Perception (Understanding Patient's Knowledge):
- Ask open-ended questions to gauge the patient’s understanding. For example, “Can you tell me what you already know about your mother’s condition?”
- Avoid repeating questions that are already answered in the patient’s notes, as it may seem like you haven’t read the case properly.

Setting: Ensure the environment is appropriate for delivering bad news.
Perception: Understand the patient’s or family's perception of the illness.
Invitation: Invite the patient or family to ask questions and express their concerns.
Knowledge: Provide the necessary information in a clear, structured manner. Deliver information in layers and allow pauses for questions.
Empathy: Show empathy and provide emotional support throughout the conversation.
Summary: Summarize the key points and ensure the patient or family understands the information provided.

Initial Disclosure:
- Avoid stating outright that you have bad news at the beginning of the conversation. This can increase anxiety.
- Instead, condition the conversation by gradually leading up to the bad news through a structured approach.
Invitation Timing:
- Invite questions and concerns early in the conversation, not after extensive data gathering. This helps manage the patient’s or family's anxiety and sets the stage for delivering bad news.
Layered Delivery:
- Break the news in layers: start by summarizing what the patient already knows, then add new information step by step.
- For example: Start with acknowledging the dementia diagnosis, then explain the current situation regarding weight loss, and finally, discuss the progression of dementia and the need for palliative care.

If Asked Mid-Conversation:
- If the patient or family asks questions before you’ve completed your planned delivery, explain that you need to provide a complete understanding of the situation to give the best possible explanation.
- Redirect to your planned flow without dismissing their concerns.

Time Management:
- Prioritize essential information and ensure the main points are covered within the given time.
- Use the two-minute warning bell as a cue to wrap up and summarize the discussion.
Safety Netting and Follow-Up:
- Always include safety netting, follow-up appointments, and provide leaflets or pamphlets for additional information.
- Ensure the patient or family knows they can reach out for further clarification if needed.

Empathy and Support:
- Show empathy throughout the conversation, acknowledge the emotional impact, and provide support.
Clear Communication:
- Ensure your communication is clear and concise, avoiding medical jargon as much as possible.
Follow the Protocol:
- Adhere strictly to the SPIKES protocol to structure the conversation effectively and meet the expectations of the examination.

Revisit the Feedback:
- Review the detailed feedback provided and practice structuring your consultations using the SPIKES protocol.
Continued Practice:
- Engage in further practice sessions to refine your approach, focusing on minimizing data gathering and enhancing your delivery of bad news.
Utilize Resources:
- Make use of available resources such as leaflets and follow-up appointments to ensure comprehensive patient support.

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